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Sciatica is the pain that radiates along the lower back through one's hips and buttocks and down each leg, the path through which the sciatic nerve passes. Sciatica typically affects only one side of the body. It most commonly occurs when a herniated disk or bone spur on the spine compresses or exerts pressure on a part of the nerve. This friction causes inflammation, pain and also may result in some numbness in the affected leg. Although the pain caused due to sciatica can be severe, a majority of the cases can be cured a great deal with just conservative treatments possibly within a few weeks. People who have severe sciatica even after six weeks of treatment might be helped by surgery to relieve the pressure on the nerve.
What are the symptoms of sciatica?
Sciatica is generalized by one or more of the following symptoms:
- Incessant pain in either side of the buttock or leg, rarely in both legs
- Pain that worsens when seated
- Weakness, numbness or difficulty in moving a leg or foot
- A sharp pain that makes it difficult to stand up or walk
- Sciatic pain can be infrequent and irritating in one patient to constant and incapacitating in another. Certain sciatica symptoms also vary widely in type, location and severity, depending upon the condition causing the sciatica (such as a lumbar herniated disc).
- While symptoms can be very painful, it is rare that permanent sciatic nerve damage results.
What are the causes of sciatica?
Six problems associated with the lower back are the most common causes of sciatica
The above condition occurs when a small stress fracture allows one vertebral body to slip forward on another. When disc space collapse, fracture, and the vertebral body slipping forward combine, the nerve can get pinched and cause sciatica.
A herniated disc develops when the soft inner core of the disc starts leaking, or herniates, through the fibrous outer core and irritates the nerve root. A herniated disc is sometimes also known as a protruding disc, slipped disc, bulging disc, ruptured disc, or a pinched nerve. Sciatica is also a common symptom of a lumbar herniated disc.
Lumbar spinal stenosis
This condition commonly causes sciatica due to a narrowing of the spinal canal. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults over age 60. The condition typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots, causing sciatica pain.
Degenerative disc disease
Disc degeneration is a natural process that develops with aging, for some people one or more degenerated discs in the lower back may irritate a nerve root and cause sciatica. Degenerative disc disease is diagnosed when a weakened disc causes extreme micro motion at a certain spinal level, and inflammatory proteins from inside the disc leak out and irritate the area.
A sciatic nerve can get irritated as it passes under the piriformis muscle in the buttock. If the piriformis muscle irritates or pinches a nerve root that includes the sciatic nerve, it can cause sciatica-like pain. It is not the clinical meaning of sciatica, but the leg pain may feel the same as sciatica caused due to nerve irritation.
Sacroiliac joint dysfunction
Irritation of the sacroiliac joint situated at the bottom of the spine can also irritate the nerve that lies on top of the sacroiliac joint, causing sciatica. The leg pain can feel the same as sciatica caused by a nerve irritation.
What is the treatment for sciatica?
Treatment for sciatica is not always necessary since it improves naturally within nearly six weeks. But if the symptoms are severe or persist, a number of treatments are available. The treatment options usually include self-help and conservative treatments, such as medication and physiotherapy. In a few cases, surgery is recommended to correct the problem of the spine that is causing the symptoms and pain.
Patients suffering from sciatica must remain as physically active as possible. Simple exercises like walking and gentle stretching can help reduce the severity of the symptoms and strengthen the muscles that support the spine. While bed rest may provide some temporary relief from pain, prolonged bed rest is often unnecessary and unhelpful.
Hot or cold compression packs on painful areas have proven to help some people in reducing the pain. Patients can make their own cold compression pack by wrapping a pack of frozen peas in a soft cloth.
If other methods of pain relief fail to work, the patient may be referred to a specialist for a local anaesthetic injection. This delivers strong anti-inflammatory and painkilling medication directly to the inflamed area around the nerves of the spine, that helps release the pressure on sciatic nerve and temporarily reduce pain.
In some cases, the general practitioner may recommend a suitable exercise plan for every patient, or they may refer the patient to a physiotherapist. A physiotherapist can train in some exercises that strengthen the muscles supporting the back and improve its flexibility. The therapists can also teach ways to improve posture and reduce any strain on the back.
Surgery is rarely needed to treat sciatica, although may be considered if the condition has an identifiable cause, such as slipped disc, the symptoms have not responded to other treatments, or the symptoms are worsening gradually. The type of surgery recommended depends on the cause of sciatica. Some surgeries are:
- Discectomy - is a surgery wherein, that part of the herniated disc pressing on the nerve is removed. It is also the most common type of surgery.
- Fusion surgery - is performed to fuse a vertebra that has slipped out of its place, by using a metal or plastic cage between the vertebra, supported by screws and metal rods.
- Laminectomy - is a procedure that is often used to treat spinal stenosis, wherein a section of vertebrae called the lamina is removed.
A large number of people have a positive result from surgery but like other surgeries, spinal surgery also carries some risks. Potential complications can be relatively minor, such as an infection at the operation site, to the more serious like permanent damage to the spinal nerves. Before choosing a spinal surgery, the surgeon will discuss the possible risks and benefits. It is important to choose the right surgeon. Spine and Neurosurgery Hospitals in India, especially in metropolitan cities like Delhi and Nagpur, provide promising treatment for sciatica problems. Also the major boost factor is the lesser price. The overall expenses of treatment in India may cost as low as 25 % of what one may have to incur in the western countries, with the same excellence and efficiency in treatment.